Treatment of Epilepsy

WHAT CAUSES SEIZURES?

Seizures occur when nerve cells discharge their electric current in an abnormal manner, much like a "short circuit". The patient may lose consciousness, and have shaking movements of all limbs, or smaller attacks may occur, with just staring spells, an unusual behavior, or movements of one arm or leg. When seizures occur again and again, the patient is said to have epilepsy. Sometimes seizures occur as an acute warning that there is an underlying problem which needs attention.

We therefore carefully investigate each case of new-onset seizures, through neurological examination, brain scan, electroencephalogram (EEG) and blood tests. We then treat the underlying cause, as well as providing medical management of the seizures. Acute causes of seizures such as these include a dramatic change in blood sugar, stroke or brain tumor.

However, in most epilepsy cases, there is no specific acute cause. Instead, perhaps a minor brain injury in the period surrounding birth or an inherited tendency toward having seizures produces the episodes. Although persons with epilepsy may have seizures frequent enough to be disabling, most people are relatively well between episodes, and lead normal lives.

HOW CAN EPILEPSY BE TREATED?

Treatment with medications usually reduces seizure frequency or eliminates seizures. In some cases, standard medications fail to provide control; these cases are called intractable. At the Comprehensive Epilepsy Center, we approach the care of these more difficult cases through the use of sophisticated techniques. These techniques include neurosurgical intervention, vagal nerve stimulation, and FDA-approved clinical trials of new investigational antiepileptic medications not otherwise available. At the New York Hospital-Cornell Medical Center Comprehensive Epilepsy Center, we have had extensive experience through clinical trials with newer agents such as gabapentin, topiramate, tiagabine and vigabatrin.

SURGERY FOR EPILEPSY

Neurologists, neurophysiologists and neuroradiologists work together with other team members to evaluate the possibility of surgical treatment of carefully-selected intractable seizure disorders. Special monitoring techniques, such as video-EEG telemetry, a simultaneous recording of the patient's EEG with a video recording of his behavior, often allow us to localize the area of the brain "responsible" for the seizures.

Extensive "mapping" of the brain, by neurodiagnostic imaging, neuropsychological testing and other means, is done to ensure that the neurosurgical approach, if chosen, is a safe and desirable option. Our neurosurgical staff proficiently meets the needs of adults and children during all stages of surgical intervention for epilepsy.

We also offer a new, experimental surgery for epilepsy, called vagus nerve stimulation, which does not involve an operation on the brain. A small pacemaker is placed under the skin, and periodically stimulates a nerve in the side of the neck with a low amount of electrical current. This process can reduce seizure frequency and severity.

HIGH QUALITY SURVEILLANCE

The Comprehensive Epilepsy Center is an active branch of the internationally regarded Neurology and Neuroscience Department at the New York Hospital-Cornell Medical Center. Individuals and families receiving care through the Comprehensive Epilepsy Center have available to them the vast resources of one of the country's most prestigious medical and teaching institutions.

State-of-the-art neurophysiologic monitoring is utilized by the Comprehensive Epilepsy Center to guide patient treatment and progress in the neonatal and pediatric intensive care units, adult medical and surgical intensive care units, as well as to provide high quality intraoperative surveillance during neurosurgery.

COMPREHENSIVE PATIENT CARE

At the Comprehensive Epilepsy Center, coordinated interdisciplinary care is a priority. Physicians, a nurse clinician, social workers, a neuropsychiatrist, language therapists, occupational and physical therapists work together with families to provide support and appropriate interventions for concerns such as self-esteem, sexuality, cognitive issues, altered parenting roles, reproductive decisions and workplace disclosure issues.

The Comprehensive Epilepsy Center has helped organize an upcoming conference in May 1997 on Women's Neurologic Health, to be held at the New York Hospital-Cornell Medical Center. Issues such as childbearing, childrearing and lifecycle changes for women with epilepsy, migraine, multiple sclerosis and other neurologic conditions will be the subject of this free conference, open to the public.

A FURTHER NOTE ABOUT CHILDREN

Many cases of childhood epilepsy are well-controlled and have a good outcome. Some children have a more difficult time, and the combination of seizures, medication effects and behavioral or learning problems requires a multidisciplinary effort where family needs are recognized as well.

Whether seen out-patient or in-patient, children receive expert medical attention with an emphasis on developmental needs. Children requiring hospitalization for monitoring, medication adjustment or surgical management are housed in a two bedded room on constant video-camera surveillance; parents are encouraged to stay overnight.

Children with hard-to-manage seizures may be considered for epilepsy surgery when treatment with anti-epileptic medication fails. Neurosurgical intervention, even at an early age, can sometimes end frequent, uncontrollable seizures, allowing children to maximize their potential. Epilepsy surgery in children serves to remove the source of the seizures, or in some cases, to disrupt pathways which spread seizures.

HORMONAL INFLUENCES ON EPILEPSY, MOOD AND BEHAVIOR

Neuroendocrinology is the study of how hormones interact with the brain. At the Neuroendocrine Division of the Comprehensive Epilepsy Center at New York Hospital-Cornell, we have particular interest in the relationships between the reproductive steroid hormones, epilepsy and behavior. Insight into the complex interactions between the reproductive steroid hormones (estradiol, progesterone and testosterone) and issues such as seizure exacerbation, mood disturbances, altered libido and fertility leads to new treatment approaches sensitive to the needs of adolescents and adults with epilepsy, migraine and other neurologic conditions.

Reproductive endocrine disorders are more common among women and men with temporal lobe epilepsy than in the general population. The temporal lobe of the brain provides important feedback to endocrine centers in the brain, therefore indirectly influencing the secretion of important chemical messengers. In some individuals with temporal lobe epilepsy, disruption of temporal lobe function may impact on this hormonal feedback system. Symptoms experienced by affected individuals, such as amenorrhea and infertility in women, and diminished libido and potency in men, can be effectively treated both by controlling seizures and by normalizing the hormonal environment.

AREAS OF SPECIAL INTEREST

The Comprehensive Epilepsy Center of New York Hospital - Weill-Cornell Medical Center provides care for all patients with seizures, no matter how complex their needs. We have a special interest in meeting family needs, and addressing women's neurologic health throughout the lifespan. We have active research interests, including new approaches to the management of status epilepticus, and the effects of epilepsy on mood and memory. The Center offers clinical trials for several new anti-convulsants, as well as new techniques such as vagus nerve stimulation.

Patient Care

Quick Reference Neurologist Lisitng

Managed Care Participation

Comprehensive Epilepsy Center

Headache Center

Memory Disorders Program

Judith Jaffe Multiple Sclerosis Center

Neurology (General)

Neuromuscular Center

Neuro-Ophthalmology

Laboratory of Clinical Neurophysiology

Neuropsychology

Neurovascular Ultrasound Lab

Parkinson's Disease & Movement Disorders Institute

Peripheral Neuropathy

Center for Sleep Medicine

Division of Stroke and Critical Care